Thursday, July 23, 2009

Medicine Rotation Exam: The Aftermath

Hmm, that was an . . . interesting experience.

My long case went okay, and I am pretty sure that I passed it with a clear margin. I really like interviewing people and can get a bit out of them because I try to listen actively, and repeat what they have said so that we are clear on their details.

The short cases are a little harder to predict. One was an upper limb neuro exam, I picked that there was something going on with his co-ordination so asked to jump straight to that because we only have a short amount of time, and they said that was fine. I worked out that it was a cerebellar lesion, but didn't pick the cause in this fellow. (It was MS. I hadn't seen MS in a patient before, so it makes it difficult.) I guessed alcoholism or trauma. (I have seen Wernicke's in a 29-year-old before, so it isn't out of the picture completely.)

The second case was an abdominal examination, which I would normally be happy with, but this fellow's abdomen was so incredibly distended with something (possibly shit or fat) and he had guarding and tenderness, so it was hard to really feel anything. I faffed around a bit, managed to mistake some fat/poop for the liver edge until I percussed, found an abdominal wall hernia, found splenomegaly, faffed around a bit when they asked how to tell the difference between the spleen and the kidney, but got the causes of splenomegaly and this specific cause in this patient.

I feel like I didn't do the examinations as smoothly as I could (when under stress . . .) and that I ummed and awed a lot. They were not the easiest exams (particularly the abdominal exam). Another one of the students saw the same patients as I did and is convinced that he failed, too.

On the bright side, if we all do badly, then they will review our results if we failed. :( The third student on the rotation is quite talented at this area, so he will do better, I think. (He is a really bright spark who specifically wants to be a physician, and will be really good.)

Unfortunately I don't find out whether or not I passed until a few weeks time, when I will be far, far away (7 hours drive) on my rural rotation. On the bright side, if I have to repeat any part of the exam, I am at a hospital so there will be plenty of opportunities to short case practise.